ForwardHealth Provider Portal Professional Claims User Guide ForwardHealth Provider Portal Professional

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    ForwardHealth Provider Portal Professional Claims

    April 22, 2020

    December 09, 2014

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    P-00970A

    Table of Contents

    1 Introduction........................................................................................................................................ 1

    2 Access the Claims Page ...................................................................................................................... 2

    3 Submit a Professional Claim .............................................................................................................. 5

    3.1 Professional Claim Panel ............................................................................................................. 6

    3.1.1 Diagnosis Panel ................................................................................................................... 7

    3.1.2 Condition Panel ................................................................................................................ 10

    3.1.3 Medicare Information (Header) Panel ............................................................................ 11

    3.1.4 Anesthesia Panel .............................................................................................................. 12

    3.1.5 Other Insurance Header Information Panel.................................................................... 12

    3.2 Detail Panel ................................................................................................................................ 16

    3.2.1 NDC Panel ......................................................................................................................... 18

    3.3 Other Insurance Detail Information Panel ............................................................................... 19

    3.4 Other Insurance EOB Information Panel .................................................................................. 21

    3.5 Medicare Information (Detail) Panel ........................................................................................ 25

    3.6 Attachments Panel..................................................................................................................... 26

    3.7 Submit the Claim ........................................................................................................................ 26

  • April 22, 2020 ForwardHealth Provider Portal Professional Claims User Guide

    1 Introduction 1

    1 Introduction

    Providers may submit professional claims directly to ForwardHealth using Direct Data Entry, an online application, available through their secure provider account on the ForwardHealth Portal.

  • April 22, 2020 ForwardHealth Provider Portal Professional Claims User Guide

    2 Access the Claims Page 2

    2 Access the Claims Page

    1. Access the Portal at https://www.forwardhealth.wi.gov/

    Figure 1 ForwardHealth Portal Home Page

    2. Click Login. The ForwardHealth Portal Login box will be displayed.

    Figure 2 ForwardHealth Portal Login

    Note: The login box can also be accessed by clicking the provider icon on the home page of the ForwardHealth Portal.

    3. Enter your username.

    https://www.forwardhealth.wi.gov/

  • April 22, 2020 ForwardHealth Provider Portal Professional Claims User Guide

    2 Access the Claims Page 3

    4. Enter your password.

    5. Click Go! Your secure provider page will be displayed.

    Figure 3 Secure Provider Page

    6. Click Claims on the main menu at the top of the page. The Claims page will be displayed.

  • April 22, 2020 ForwardHealth Provider Portal Professional Claims User Guide

    2 Access the Claims Page 4

    Figure 4 Claims Page

    All claim type submission options are available from this page.

  • April 22, 2020 ForwardHealth Provider Portal Professional Claims User Guide

    3 Submit a Professional Claim 5

    3 Submit a Professional Claim

    1. Click Submit Professional Claim in the “What would you like to do?” section of the Claims page. The Professional Claim form will be displayed.

    Figure 5 Professional Claim Form

  • April 22, 2020 ForwardHealth Provider Portal Professional Claims User Guide

    3 Submit a Professional Claim 6

    3.1 Professional Claim Panel

    Users may enter a claim’s header information on the Professional Claim panel.

    Note: Fields marked with an asterisk (*) are required fields.

    Figure 6 Professional Claim Panel

    Information cannot be entered in the ICN field. ForwardHealth will automatically assign an Internal Control Number (ICN) when the claim is submitted.

    For all providers except hospitals, the Provider ID field will be populated with the National Provider Identifier (NPI) under which the user is logged in.

    For users logged in with a hospital account, this field will have drop-down menu containing the hospital’s main NPI and any sub-part NPIs assigned to that hospital.

    From the Provider ID drop-down menu, select the NPI to be indicated on the claim being submitted.

    Figure 7 Provider ID Drop-down Menu for Hospital Accounts

    2. Enter the member’s ID in the Member ID field.

    Note: After entering the member’s ID, click anywhere on the gray area of the form. The Last Name, First Name, MI, and Date of Birth fields will populate with the member’s information.

    3. Enter the provider’s internal number assigned to the patient’s account in the Patient Account # field.

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    3 Submit a Professional Claim 7

    4. Enter the provider-assigned medical record number for the service(s) being processed in this claim in the Medical Record # field.

    5. Enter the NPI of any provider who performed services in the Rendering Provider field.

    6. Enter the NPI of the provider, or providers, who referred the member for services in the Referring Provider 1 and Referring Provider 2 fields if applicable. Users may enter an NPI in the field, or search for the NPI using the adjoining Search link.

    Note: If a field exists at both the header and detail level, enter the information in one or the other but not necessarily both. The header will apply automatically to all details. Enter information at the detail only if different than the header value for these details.

    7. Select a Medicare disclaimer status from the Medicare Disclaimer drop-down menu for traditional Medicare Part A, traditional Medicare Part B, or Medicare Advantage payers. The only valid options include the following:

     No Disclaimer — No disclaimer exists.

     7 Mcare disallowed/denied pymt — Medicare has disallowed or denied the payment according to Medicare rules. This code applies when Medicare denies the claim for reasons related to policy (not billing errors), or the member's lifetime benefit, spell of illness, or yearly allotment of available benefits is exhausted.

     8 Noncovered Mcare srv — The service provided to the member was not billed to Medicare because the service is not covered under certain circumstances.

    Note: The Medicare Disclaimer field should be used to indicate a claim by a Medicare provider for a member with Medicare coverage that the provider wishes to have processed as if it were a primary claim by ForwardHealth, i.e., not secondary to Medicare. If a Medicare disclaimer is used, no information should be entered in the Medicare Information (Header) or the Medicare Information (Detail) panels.

    8. The Other Insurance Indicator drop-down menu is no longer used on claims submitted on or after June 14, 2014, but remains on this panel for viewing claims submitted before June 14, 2014. Providers are required to use the Other Insurance Header, Detail, and EOB Information panels to report other insurance (OI) information.

    9. Enter the total charge for the service(s) being provided to the member in the Total Charge field.

    10. Enter the amount that was paid by a commercial insurance carrier in the Other Insurance Amount field.

    Information cannot be entered in the Total Amount Paid field. The total amount paid will be automatically calculated after the claim is submitted.

    3.1.1 Diagnosis Panel

    1. Click Diagnosis at the bottom of the Professional Claim panel.

  • April 22, 2020 ForwardHealth Provider Portal Professional Claims User Guide

    3 Submit a Professional Claim 8

    Figure 8 Diagnosis Link

    The Diagnosis panel will be displayed.

    Figure 9 Diagnosis Panel

    2. Enter a diagnosis code from the International Classification of Diseases (ICD) coding structure in the Diagnosis 1 field or search for a code using the Search link to the right of the field.

    Note: Do not use a decimal point when entering a diagnosis code. For example, for ICD diagnosis code 041.00, enter 04100.

    For more information about covered services and reimbursement, refer to the ForwardHealth Online Handbook.

    To search for a diagnosis code, complete the following steps:

     Click Search to the right of the applicable Diagnosis field. The Diagnosis search panel will be displayed.

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